自体髌腱与自体四股腘绳肌腱重建前交叉韧带对髌股关节软骨影响的关节镜对比观察研究

Arthroscopic Observation on the Effects of Anterior Cruciate Ligament Reconstruction Using Autogenous Patella-Tendon and Autogenous Hamstring-Tendon on the Articular Cartilage of Patellofemoral Joint

目的:通过再次关节镜的观察了解前交叉韧带重建对髌股关节软骨的影响,以及应用自体髌腱和自体腘绳肌腱重建前交叉韧带对髌股关节软骨影响的差异。对象与方法:自2000年12月～2004年12月间有631例前交叉韧带断裂的患者在我科进行关节镜下前交叉韧带重建,并因要取内固定物再次入院进行了二次关节镜检查,其中取自体髌腱组103例,取自体腘绳肌腱组528例。分部位、程度记录两组患者重建前后两次关节镜检查的髌股关节软骨损伤情况并进行统计分析。结果:103例取髌腱重建的患者在前交叉韧带重建时关节镜检查共发现59处髌股关节软骨损伤,前交叉韧带重建后再次关节镜检查共发现新增56处软骨损伤,其中新增髌骨软骨损伤28处,新增滑车软骨损伤28处。平均每例患者增加0.54处髌股关节软骨损伤,增加的软骨损伤程度以2度损伤为主。528例取腘绳肌腱重建的患者在前交叉韧带重建时关节镜检查共发现265处髌股关节软骨损伤,前交叉韧带重建后再次关节镜检查共发现新增263处髌股关节软骨损伤,其中新增髌骨软骨损伤107处,新增滑车软骨损伤156处,平均每例患者增加0.50处髌股关节软骨损伤,增加的软骨损伤程度以2度损伤为主。前交叉韧带重建后各部位软骨损伤程度的加重在取髌腱组和取腘绳肌腱组之间无显著性差异(P>0.05)。结论:前交叉韧带重建后,髌股关节软骨损伤有一定程度的增多与加重,以2度软骨损伤增多为主,取髌腱重建前交叉韧带与取腘绳肌腱重建相比并不会增加更多的髌股关节软骨损伤。

Purpose To investigate the effect of anterior cruciate ligament reconstruction on articular cartilage of patellofemoral joint through second - look arthroscopy and to investigate the difference between autogenous patella- tendon reconstruction and autogenous hamstring - tendon reconstruction. Methods Six hundred and thirty one cases with ACL rupture underwent reconstructive ACL surgery assisted with arthroscopy from December 2000 to December 2004, and they had second - look arthroscopy because of taking away the hardware, in which 103 cases were reconstructed with patella tendon （patella tendon group）, 528 cases were reconstructed with hamstring tendon （hamstring tendon group）. Results Fifty nine （59） sites of cartilage lesions in patellofemoral joint were found by arthroscopy in patella tendon group during surgery. 56 new cartilage lesions were found at second - look arthroscopy after ACL reconstruction （including 28 at patella and 28 at trochlea）. Average 0.54 site of cartilage lesions per patient increased. Most added cartilage lesions were 2 degree. 265 sites of cartilage lesions in patellofemoral joint were found by arthroscopy in 528 patients underwent ACL reconstruction with autogenous hamstring tendon. 263 cartilage lesions were added at second - look arthroscopy after ACL reconstruction, 107 lesions were located at patella and 156 were at trochlea. Average 0.50 site cartilage lesions per patient increased. Most added cartilage lesions were categorized as II degree. There was not significant different in the aggravation of cartilage lesion between the two groups at second - look arthroscopy （ P 〉 0.05）. Conclusion Cartilage lesions of patellofemoral joint was increased to a certain extent at second - look arthroscopy after ACL reconstruction. Most added cartilage lesions were categorized as II degree. No more cartilage lesions of patella - femoral joint were found in patients reconstructed either with autogenous patella - tendon or with autogenous hamstring - tendon.